Pediatric Education and Research

 Indwelling catheters serve as nidus for thrombosis and neonatal thrombotic events are reported in low birth weight neonates with history of umbilical catheter or peripherally inserted central catheter. The knowledge of natural history of thrombotic events is not known in newborns. Management options includes ”wait and watch” policy (expected management), medical treatment with low molecular weight heparin (LMWH) or surgery. We report a case of late preterm complicating with superior vena cava thrombosis extending to tricuspid valves and complete recovery of thrombus without anticoagulation therapy.

Keywords: Thrombosis; Umbilical Catheter; Wait and Watch.

 Neuroblastoma is the most common solid tumor in newborn and the most common extracranial tumor in infancy. Common site for tumor is abdominal, however it could be arises from paraspinal area of the sympathetic nervous system and account for 11 to 26% of all neuroblastoma cases. Thoracic neuroblastoma (TNBL) has a relatively favourable prognosis and better outcome then neuroblastoma arising in other area. We report a case of intrathoracic neuroblastoma in newborn presenting as respiratory distress, treated successfully with chemotherapy and subsequent lobectomy of lung tissue.

Keywords: Newborn; Respiratory Distress; Thoracic Neuroblastoma.

 Objective: To assess the prevalence and the risk factors of pulmonary hypertension in children with sickle cell disease. Methods: Children (age: 3- 15 y) diagnosed with sickle cell disease were included in the study conducted between August 2016 to July 2018. All relevant past history of hospitalisation, crisis (esp. acute chest syndrome crisis), blood transfusion and medication history was recorded. A thorough physical examination, blood investigations (CBC and Reticulocyte Count) and 2D Echocardiography was carried out for all the enrolled patients. Results: In this study, 18.57% of the study population was found to have PAH with TRV > 2.5 m/s. No statistically significant co-relation was found between age, gender, religion, anthropometry, blood group type, sickle phenotype, total leukocyte count and PAH. There was a statistically significant association of pulmonary hypertension with low Hb, high reticulocyte count and platelet count, history of repeated hospital admissions and blood transfusions and a positive history of ACS.It was also found that patients who were on hydroxyurea treatment were less likely to develop PAH. Conclusion: One-fourth of pediatric sickle cell disease patients demonstrated presence of pulmonary hypertension. Risk factors like low Hb, elevated platelet and reticulocyte count, repeated number of hospital admissions, episodes of ACS and blood transfusions were significantly associated with an elevated TRV finding on Echocardiography in children with Sickle Cell Disease. Hydroxyurea therapy too played a significant role in this study in reducing the chances of having PAH. These patients need to be monitored and followed-up after treatment to assess need for later treatment

Keywords: Sickle Cell Disease; Pulmonary Hypertension; Doppler Echocardiography; Tricuspid Regurtiant Velocity

 Background: Dengue is a major international problem that is prevalent in tropical and sub-tropical countries. It is estimated that worldwide nearly 2.5 billion people continue to live at risk of contracting the infection while 50 million cases and 24,000 deaths tend to occur in 100 endemic countries. Hepatic dysfunction is common in dengue fever and the degree of liver dysfunction in children varies from mild injury with to severe injury. Methods: Prospective and descriptive study was conducted on all the laboratory confirmed cases of dengue fever in children admitted at our institute in Department of Paediatrics over a period of 1 year clinically and biochemically. Results: This study reveals, the prevalence of hepatic dysfunction in 30.7% (160/500) of the cases. Among the gender and age, majority of the hepatic dysfunction were seen in males 53.7% (86/160) and in the age group of 10- 18 years 45% (72/160). Based on the severity, majority of hepatic dysfunction with severe dengue cases were 60% (96/160). Among clinical findings, most common symptom was jaundice 23.7% (38/160) and commonest sign was hepatomegaly 39.3% (63/160). The commonest liver function test altered was AST level in 46.2% (74/160) of the cases. Commonest abdominal USG finding was gall bladder edema in 90.6% (145/160) of the cases. The mortality was nil in this study. Conclusions: This study concludes prevalence of hepatic dysfunction was seen 30.7%, most of them seen in severe dengue 60% of the cases suggesting any febrile child with hepatic dysfunction, dengue infection should be suspected.

Keywords: Dengue Fever; Jaundice; Hepatic Dysfunction.